Consolidating p17

So, I think there is a tailored approach to maintenance therapy.

At our center, for instance, standard risk would get lenalidomide.

The thing that was interesting to me in the data, Amrita, was the high-risk group.

There was a 48% progression-free survival in favor of the RVD consolidation, compared to 40% for the tandem and no-RVD consolidation in the other 2 arms.

The HOVON study that was published years ago looking at bortezomib in the maintenance setting suggested benefit for high-risk subsets.

And then, we’ve published a small series suggesting that an IMi D and a proteasome inhibitor, together, really can alter the natural history of patients with 17p deletion.

Do we really need to continue patients on maintenance therapy if they are MRD-negative?Now, I think that’s interesting because there may lie a clue.Our policy is: consolidation is reasonable to consider, particularly in high-risk groups.And I would include in that category patients who don’t achieve a complete remission to intensification.Keith Stewart, MB, CHB: What about maintenance therapy? The English had an update of their trial with lenalidomide maintenance. Sagar Lonial, MD: I think across the board, certainly in the meta-analysis, as well as the English, the MRC trial…It seems that all of these trials use maintenance routinely now. Keith Stewart, MB, CHB: The audience may not be familiar with the meta-analysis, so why don’t you tell them what that was?

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